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Nuance Communications Focuses on Practical Application of AI Ahead of HIMSS18

Posted on January 31, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Is there a hotter buzzword than Artificial Intelligence (AI) right now? It dominated the discussion at the annual RSNA conference late last year and will undoubtedly be on full display at the upcoming HIMSS18 event next month in Las Vegas. One company, Nuance Communications, is cutting through the hype by focusing their efforts on practical applications of AI in healthcare.

According to Accenture, AI in healthcare is defined as:

A collection of multiple technologies enabling machines to sense, comprehend, act and learn so they can perform administrative and clinical healthcare functions. Unlike legacy technologies that are only algorithms/ tools that complement a human, health AI today can truly augment human activity.

One of the most talked about applications of AI in healthcare is in the area of clinical decision support. By analyzing the vast stores of electronic health data, AI algorithms could assist clinicians in the diagnosis of patient conditions. Extending this idea a little further and you arrive in a world where patients talk to an electronic doctor who can determine what’s wrong and make recommendations for treatment.

Understandably there is a growing concern around AI as a replacement for clinician-led diagnosis. This is more than simply fear of losing jobs to computers, there are questions rightfully being asked about the datasets being used to train AI algorithms and whether or not they are truly representative of patient populations. Detractors point to the recent embarrassing example of the “racist soap dispenser” – a viral video posted by Chukwuemeka Afigbo – as an example of how easy it is to build a product that ignores an entire portion of the population.

Nuance Communications, a leading provider of voice and language solutions for businesses and consumers, believes in AI. For years Nuance has been a pioneer in applying natural language processing (NLP) to assist physicians and healthcare workers. Since NLP is a specialized area of AI, it was natural (excuse the pun) for Nuance to expand into the world of AI.

Wisely Nuance chose to avoid using AI to develop a clinical decision support tool – a path they could have easily taken given how thousands use their PowerScribe platform to dictate physician notes. Instead, they focused on applying AI to improve clinical workflow. Their first application is in radiology.

Nuance embedded AI into their radiology systems in three specific ways:

  1. Using AI to help prioritize the list of unread images based on need. Traditionally images are read on a first-in, first-out basis (with the exception being emergency cases). Now an AI algorithm analyzes the patient data and prioritizes the images based on acuity. Thus, images for patients that are more critical rise to the top. This helps Radiologists use their time more effectively.
  2. Using AI to display the appropriate clinical guidelines to the Radiologist based on what’s being read from the image. As information is being transcribed through PowerScribe, the system analyzes the input in real-time and displays the guideline that matches. This helps to drive consistency and saves time for the Radiologist who no longer has to manually look up the guideline.
  3. Using AI to take measurements of lesion growth. Here the system analyzes the image of lesions and determines their size which is then displayed to the Radiologist for verification. This helps save time.

“There is a real opportunity here for us to use AI to not only improve workflows,” says Karen Holzberger, Vice President and General Manager of Diagnostic Solutions at Nuance. “But to help reduce burnout as well. Through AI we can reduce or eliminate a lot of small tasks so that Radiologists can focus more on what they do best.”

Rather than try to use AI to replace Radiologists, Nuance has smartly used AI to eliminate mundane and non-value-add tasks in radiology workflow. Nuance sees this as a win-win-win scenario. Radiologists are happier and more effective in their work. Patients receive better care. Productivity improves the healthcare system as a whole.

The Nuance website states: “The increasing pressure to produce timely and accurate documentation demands a new generation of tools that complement patient care rather than compete with it. Powered by artificial intelligence and machine learning, Nuance solutions build on over three decades of clinical expertise to slash documentation time by up to 45 percent—while improving quality by 36 percent.”

Nuance recently doubled-down on AI, announcing the creation of a new AI-marketplace for medical imaging. Researchers and software developers can put their AI-powered applications in the marketplace and expose it to the 20,000 Radiologists that use Nuance’s PowerScribe platform. Radiologists can download and use the applications they want or that they find interesting.

Through the marketplace, AI applications can be tested (both from a technical perspective as well as from a market acceptance perspective) before a full launch. “Transforming the delivery of patient care and combating disease starts with the most advanced technologies being readily available when and where it counts – in every reading room, across the United States,” said Peter Durlach, senior vice president, Healthcare at Nuance. “Our AI Marketplace will bring together the leading technical, research and healthcare minds to create a collection of image processing algorithms that, when made accessible to the wide array of radiologists who use our solutions daily, has the power to exponentially impact outcomes and further drive the value of radiologists to the broader care team.”

Equally important is the dataset the marketplace will generate. With 20,000 Radiologists from organizations around the world, the marketplace has the potential to be the largest, most diverse imaging dataset available to AI researchers and developers. This diversity may be key to making AI more universally applicable.

“AI is a nice concept,” continued Holzberger. “However, in the end you have to make it useful. Our customers have repeatedly told us that if it’s useful AND useable they’ll use it. That’s true for any healthcare technology, AI included.”

LTPAC – A Vibrant Hidden World

Posted on November 20, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

PointClickCare, makers of a cloud-based suite of applications designed for long-term post acute care (LTPAC), recently held its annual user conference (PointClickCare SUMMIT) in sunny Orlando, Florida. The conference quite literally shone a light on the LTPAC world – a world that is often overlooked by those of us that focus on the acute care side of healthcare. It was an eye-opening experience.

This year’s SUMMIT was the largest in the company’s history, attracting over 1,800 attendees from skilled nursing providers, senior living facilities, home health agencies and Continuing Care Retirement Communities. Over the three days of SUMMIT I managed to speak to about 100 attendees and every one of them had nothing but praise for PointClickCare.

“I couldn’t imagine doing my work without PointClickCare. I wouldn’t even know where to start if I had to use paper.”

“I don’t want to go back to the days before we had PointClickCare. We had so much paperwork back then and I used to spend an hour or two after my shift just documenting. Now I don’t have to. I track everything in the system as I go.”

“PointClickCare lets us focus more on the people in our care. We have the ability to do things that would have been impossible if we weren’t on an electronic system. We’re even starting to share data with some of our community partners.”

Contrary to what many believe, not every skilled nursing provider and senior living facility operates with clipboards and fax machines. “That’s one of the biggest misconceptions that people have of the LTPAC market,” says Dave Wessinger, Co-Founder and CTO at PointClickCare. “Almost everyone assumes that LTPAC organizations use nothing but paper or a terrible self-built electronic solution. The reality is that many have digitized their operations and are every bit as modern as their acute care peers.”

According to a recent Black Book survey, 19 percent of LTPAC providers have now adopted some form of an Electronic Health Record (EHR) system. In 2016, Black Book found the adoption rate was 15 percent. The Office of the National Coordinator recently published a data brief that showed adoption of EHRs by Skilled Nursing Facilities (SNFs) had reached 64% in 2016.

Although these numbers are low compared to the +90% EHR adoption rate by US hospitals, it does indicate that there are many pioneering LTPAC providers that have jumped into the digital world.

“It’s fun to be asked by our clients to work with their acute care partners,” explains BJ Boyle, Director of Product Management at PointClickCare. “First of all, they are surprised that a company like PointClickCare even exists. They are even more surprised when we work with them to exchange health information via CCD.”

Boyle’s statement was one of many during SUMMIT that opened my eyes to the innovative technology ecosystem that exists in LTPAC. Further proof came from the SUMMIT exhibit hall where no less than 72 partners had booths set up.

Among the exhibitors were several that focus exclusively on the LTPAC market:

  • Playmaker. A CRM/Sales solution for post-acute care.
  • Hymark. A technical consultancy that helps LTPAC organizations implement and optimize PointClickCare.
  • Careserv. A LTPAC cloud-hosting and managed services provider.

And some with specialized LTPAC offerings:

  • Care.ly. An app that helps families coordinate the care of their elderly loved ones with senior care facilities.
  • McBee Associates. Financial and revenue cycle consultants that help LTPAC organizations.

I came away from SUMMIT with a newfound respect for the people that work in LTPAC. I also have a new appreciation for the innovative solutions being developed for LTPAC by companies like PointClickCare, Care.ly and Playmaker. This is a vibrant hidden world that is worth paying attention to.

Note: PointClickCare did cover travel expenses for Healthcare Scene to be able to attend the conference.

Optimization Dominates CHIME17 Discussions

Posted on November 8, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

“Our EHR Implementation is done”

“We completed our EHR roll-out last year”

“The last EHR module has gone live”

With these words, CIO presenters at the recent CHIME Fall CIO Forum (CHIME17) ushered in a new era in Healthcare IT. Instead of EHR implementations dominating the discussion, optimization was the hot topic of discussion at the event.

“It’s clear to us that CIOs are dedicating more time and energy towards optimizing their systems rather than just implementing them”, says Ed Rucinski, Senior Vice President Worldwide Healthcare Sales at Nuance and CHIME17 attendee. “Our clients, for example, are looking for ways to simplify the documentation physicians have to do in their EHRs so that they can focus their attention back on helping patients.”

Finding ways to better utilize the EHR infrastructure was the subject of many CHIME17 sessions. In one, Sallie Arnett, Vice President Information Systems and Chief Information Officer at Licking Memorial Health Systems, presented how her organization is leveraging EHR and patient monitoring data to detect the early signs of sepsis. Over 62 lives were saved through the work of Arnett and the staff at Licking Memorial.

These results would not have been possible without the investments made in EHR implementations and other digitization efforts.

Several sessions at CHIME17 were centered on the changing role of CMIOs. For the past several years CMIOs have been synonymous with EHR implementations. Now with EHRs up and running, CHIME presenters spoke about how CMIOs were morphing into CHIOs – Chief Health Information Officers – charged with extracting clinical value from the data within the hospital’s systems. This shift in focus is further evidence that healthcare is beginning to move beyond implementation and that we are entering a time of EHR optimization.

The new focus on optimization is a welcome development. It signifies that we are finally near the end of the road-building phase of the inudstry’s EHR journey and we are getting to the phase where we start building things to make the roads useful (like gas stations, diners and cars).

Personally I am looking forward to what the next few years will bring. It will be exciting to see how decision support tools, predictive analytics, artificial intelligence, personalized medicine applications and population health systems will leverage the data that is accumulating in EHRs. The next few years will be truly interesting for CIOs.

Nuance Takes Page from Healthcare Clients in Petya Outage Aftermath

Posted on November 6, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On June 27th the Petya Malware (or NotPetya or ExPteya) struck Nuance Communications (NASDAQ: NUAN). For days the company’s eScription speech-recognition platform were unavailable, forcing thousands of healthcare clients to find alternatives for their medical transcription. During the crisis and in the weeks that followed, Nuance borrowed a page from their healthcare clients: not offering false hope and deconstructing the incident to learn from it.

At the recent CHIME Fall Forum in San Antonio Texas, I had the opportunity to sit down with Brenda Hodge, Chief Marketing Officer – Healthcare and Ed Rucinski, Senior Vice President of World Wide Healthcare Sales of Nuance to talk about the Petya outage and where the company is headed.

“The challenge we faced with Petya brought us all together as a company,” explained Ed. “When our systems went offline, the entire organization rallied together. We had engineers and support staff who slept at the office on couches and cots. We had developers who went with less than 2hrs of sleep for 4 days straight because they wanted to help clients and bring our systems back online as quickly as possible. We became a nameless and rank-less organization working towards a common goal.”

As the outage went from minutes to hours to days, Nuance resisted the temptation to offer false hope to its clients. Instead, the company opted to be truthful and transparent. Nuance sent emails and directly called clients to let them know they had suffered a cyber attack, that the full extent of the damage was not known and that they did not know when their systems would be back online. The company did, however, commit to providing regular updates and being available to answer questions and address concerns.

The following is an abbreviated excerpt from a Nuance communication posted online by one of its clients:

Nuance corporate systems were unfortunately affected by a global cyber attack today. We went into immediate security protocol by shutting down our hosted production systems and platforms. There is no update at this time as to when the accounts will be back online but we will be holding regular calls throughout the day and night to gain insight into the timeline for resolution and I will update you again when I have more info. We are sorry for the inconvenience this outage has caused and we are working diligently to get things back online.

Clinicians are coached never to give patients in crisis or their families false hope. They calmly explain what happened, state the facts and talk about potential next steps. They do not, however, say that “things will be alright”, even though they know that is what everyone desperately wants to hear. Nuance used this same protocol during the Petya outage.

The company also used protocols similar to those used following an adverse event.

Healthcare is complex and despite the best efforts and best intentions of care teams, errors occur. These errors are referred to as adverse events. Adverse events that impact patient safety or that cause actual harm to patients are thoroughly documented, deconstructed and analyzed by clinical leaders as well as risk managers. The lessons gleaned from these unfortunate events are captured and used to improve operations. The goal is to prevent or mitigate the impact of similar events in the future.

After their systems were fully restored, the Nuance team embarked on a thorough review of the incident – from technical procedures to client communication protocols.

“We learned a lot through this incident” says Hodge. “We got a first-hand education on how sophisticated malware has become. We’ve gone from viruses to malware to ransomware to coordinated nation-state attacks. That’s what Petya really is – a coordinated attack on company infrastructure. Now that we have been through this type of attack, we have put in new processes and technologies to prevent similar attacks in the future. Most importantly we have made investments in improving our response to these types of attacks.”

Nuance has gone one step further. They have committed to sharing their painful lessons learned with other companies and healthcare institutions. “Like it or not, we are all in this together”, continued Hodge. “The Petya attack came on the heels of the WannaCry ransomware attack that impacted many of our healthcare clients – so there was a lot of empathy from our clients. In fact this whole incident has created a sense of solidarity in the healthcare technology community. Cyber attacks are not going to stop and we need to come together as an industry so that we are as prepared as we can be for the next one.”

“It’s unfortunate that it took an incident like this to show us what we are made of,” says Rucinski. “We had executives making coffee and fetching lunch for the support teams. We had leaders offering to run errands for staff because they knew they were too tired to keep up with those types of things. In the end we found out we truly embody the values and principles that we have hanging on posters around the office.”

Moving from “Reporting on” to “Leading” Healthcare – A Conversation with Dr. Halee Fischer-Wright, President & CEO of MGMA

Posted on October 11, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

In Chapter 3 of Dr. Halee Fischer-Wright’s new book Back to Balance, she writes: “People are increasingly being treated as if they are the same. Science and data are being used to decrease variability in an attempt to get doctors to treat patients in predictable ways.” This statement is Fischer-Wright’s way of saying that the current focus on standardization of healthcare processes in the quest to reduce costs and increase quality may not be the brass ring we should be striving for. She believes that a balance is needed between healthcare standardization and the fact that each patient is a unique individual.

As president of the Medical Group Management Association (MGMA), a role Fischer-Wright has held since 2015, she is uniquely positioned to see first-hand the impact standardization (from both legislative and technological forces) has had on the medical profession. With over 40,000 members, MGMA represents many of America’s physician practices – a group particularly hard hit over the past few years by the technology compliance requirements of Meaningful Use and changes to reimbursements.

For many physician practices Meaningful Use has turned out to be more of a compliance program rather than an incentive program. To meet the program’s requirements, physicians have had to alter their workflows and documentation approaches. Complying with the program and satisfying the reporting requirements became the focus, which Fischer-Wright believes is a terrible unintended consequence.

“We have been so focused on standardizing the way doctors work that we have taken our eyes off the real goal,” said Fischer-Wright in and interview with HealthcareScene. “As physicians our focus needs to be on patient outcomes not whether we documented the encounter in a certain way. In our drive to mass standardization, we are in danger of ingraining the false belief that populations of patients behave in the same way and can be treated through a single standardized treatment regimen. That’s simply not the case. Patients are unique.”

Achieving a balance in healthcare will not be easy – a sentiment that permeates Back to Balance, but Fischer-Wright is certain that healthcare technology will play a key role: “We need HealthIT companies to stop focusing just on what can be done and start working on enabling what needs to be done. Physicians want to leverage technology to deliver better care to patient at a lower cost, but not at the expense of the patient/physician relationship. Let’s stop building tools that force doctors to stare at the computer screen instead of making eye contact with their patients.”

To that end, Fischer-Wright issued a friendly challenge to the vendors in the MGMA17 exhibit hall: “Create products and services that physicians actually enjoy using. Help reduce barriers between physician, patients and between healthcare organizations. Empower care don’t detract from it.”

She went on to say that MGMA itself will be stepping up to help champion the cause of better HealthIT for patients AND physicians. In fact, Fischer-Wright was excited to talk about the new direction for MGMA as an organization. For most of its history, MGMA has reported on the healthcare industry from a physician practice perspective. Over the past year with the help of a supportive Board of Directors and active members, the MGMA leadership team has begun to shift the organization to a more prominent leadership role.

“We are going to take a much more active role in healthcare. We are going to focus on fixing healthcare from the ground up –  from providers & patients upwards. In the next few years MGMA will be much bigger, much strong and even more relevant to physician practices. We are forging partnerships with other key players in healthcare, federal/state/local governments and other associations/societies.“

Members should expect more conferences, more educational opportunities and more publications on a more frequent basis from MGMA going forward. Fischer-Wright also hinted at several new technology-related offerings but opted not to provide details. Looking at the latest news from MGMA on their revamped data-gathering/analytics, however, it would not be surprising if their new offerings were data related. MGMA is one of the few organizations that regularly collects information on and provides context on the state of physician practices in the US.

It will be exciting to watch MGMA evolve in the years ahead.

MGMA17 Day 1 – Drawing Inspiration from Consumer Experience

Posted on October 9, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last night, attendees celebrated the opening of the Medical Group Management Association’s annual conference (MGMA17) in Anaheim CA with a block party that featured local food trucks instead of traditional food-stations. This welcome twist allowed attendees to sample small portions from several vendors.

The block party was a reflection of the exhibitor reception that happened earlier in the evening. With just 90 minutes, attendees could only sample a small portion of the 300 vendors that filled two halls in the Anaheim Convention Center. Despite that short amount of time, a key theme emerged – consumer experiences are serving as inspiration for HealthIT companies.

Ken Comée, CEO of CareCloud, summed it up this way: “Patients have high expectations from their healthcare providers now. They want the same level of service and convenience that they get from Amazon, Uber, OpenTable and banks.”

Prominently featured in the CareCloud booth was Breeze – a recently announced platform developed in partnership with First Data (see this blog post for more details). Comée had this to say about their new platform “If I had to compare Breeze to a consumer experience, I would have to say that it is most similar to checking in for a flight. Very few people check in for their flight in-person at the airport anymore. Almost everyone checks in at home on their computer or via their phone well ahead of their flight. You fill in all the relevant information online and you just show up to the airport and go where you need to go. There’s no paperwork you have to fill out, no need to arrive early…it’s just a smooth seamless experience. Armed with Breeze, our clients can now offer that same airline check-in experience with new as well as returning patients.”

A few booths over, David Rodriguez founder of NextPatient, talked about how OpenTable was one of the inspirations for their online appointment-booking platform. “In today’s world, when a person arrives at the website of a restaurant, they want to be able to see the times when they can make a reservation and they want to be able to click the time they want, fill in no more than 2 or 3 key pieces of information and lock it in. That’s what we offer physician practices – an elegant way to allow patients to click and book an appointment right from the practice’s own website without complex coding.”

Calibrater Health, a company that texts surveys to patients after a visit and creates “tickets” for any responses with a low NPS, was inspired by ZenDesk. Though not technically a consumer-facing application, ZenDesk does help companies forge and manage relationships with end-users by streamlining customer-service workflows, something Calibrater brings to its clients.

Patient engagement vendor, Relatient, drew inspiration from salon experiences. For many years it has been common practice in the salon and spa industries to send customers friendly reminders of their upcoming appointments via voice, text and email. Not only did these reminders reduce no-shows, but they also helped to improve customer loyalty. The Relatient solution brings those same benefits to healthcare organizations.

The night’s most thoughtful story of consumer inspiration came from Aaron Glauser, Senior Director of Product Marketing at AdvancedMD. “If I had to pick a consumer experience that inspires me and that we are closest to, it’d have to be Amazon. When you search Amazon for a product, a lot of matching entries come up – just like searching online for a doctor. You then narrow the search by looking at the star ratings and the reviews. Once you decide on a product, you click in and you decide how, when and where you want it delivered. That’s how patients want to book appointments. With AdvancedMD they can choose an open appointment time and they can even opt for a telemedicine appointment. That’s analogous to whether I want the physical book or the Kindle version on Amazon. Then as a user I get to choose how I want to pay for my Amazon purchase – which we can offer through AdvancedMD.”

Whether its Amazon, Zendesk, OpenTable, a salon or an airline that has served as inspiration. What was made clear on Day 1 of MGMA17’s exhibit hall is that consumer-experiences have become an important factor in the design of HealthIT solutions…and healthcare will be better for it.

Telus Health Continues EMR M&A Strategy – Acquires Nightingale Informatix

Posted on July 18, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Telus Health, a Canadian based healthcare technology and services firm that is a division of one of Canada’s largest telco operators (Telus Communications), recently announced the acquisition of Nightingale Informatix for $14 Million CDN (approximately $10.4M USD).

You can read the announcement here.

This is the latest in a string of acquisitions that Telus has made over the past 5 years in the Canadian ambulatory EMR space. Med Access, Wolf Medical Systems, Kinlogix, MD Physician Services, Medesync and now Nightingale are all part of Telus Health’s product portfolio. With these acquisitions Telus is now by far the most dominant player in the Canadian ambulatory market. There are only a handful of vendors remaining – the largest of which is Vancouver’s QHR Technologies.

EMR consolidation in Canada was inevitable. The small market size could not sustain the more than 50 EMR vendors that cropped up in the heyday of adoption. As well, unlike in the US, the government in Canada did not pour billions of dollars to encourage physicians to adopt EMR technologies. The incentive programs in Canada were handled by the provinces and were much smaller in scale. Thus the Canadian market was ripe for consolidation and Telus has been aggressively seizing these opportunities.

It is a little surprising that none of the US EMR vendors have looked north of the border for growth opportunities. With a single payer system and unique patient identifiers, you would think the Canadian market would be enticing. However, no US ambulatory EMR has made significant in-roads.

Missed opportunity? or perhaps a wise decision to focus at home?

*Disclosure – This writer was VP of Marketing at Nightingale Informatix from 2012-2014.

[CORRECTION – July 19, 2016 2:11pm ET – The original post erroneously reported that Telus had acquired Healthscreen, EMIS and Clinicare EMRs. These three EMRs were in fact acquired by QHR Technologies and not Telus. This post was updated with a corrected list of Telus acquisitions]

5 Reasons Why Canada Could Be a Hotbed for EHR innovation

Posted on June 4, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

From June 5th to 8th thousands of Canadian HealthIT professionals, government representatives, hospital leaders and policy consultants will gather for the annual eHealth Conference (#eHealth2016) in Vancouver. This event is like HIMSS, but smaller and focused on Canada.

Full disclosure: I am Canadian, but I spend about 80% of my time focused on US Healthcare. I manage to stay informed about the happenings in my home country through the tweets and posts of people like Glenn Lanteigne @GlennLanteigne, Mark Casselman @markcasselman, Michael Martineau @eHealthMusings, Colleen Young @colleen_young and Pat Rich @pat_health

Ahead of the #eHealth2016 conference Pat Rich sent out this tweet:

This tweet got me thinking about the state of EHRs in my home country. After hours of catching up on the latest Canadian EHR news – a light bulb went off – Canada could be the ideal test bed for new EHR innovations.

Here’s 5 reasons why

Reason 1 – No Meaningful Use, MACRA or MIPS

Like the US, Canada did allocate government dollars to help encourage the adoption of EHRs by physician practices and healthcare institutions. However, the dollars given out to Canadians paled in comparison to the US $34B CMS program. In fact, in some provinces (like Quebec) the incentive payments were so insignificant that many choose not to fill out the paperwork to receive their funding.

As well, none of the incentive programs have attestation requirements similar to the US Meaningful Use criteria. Nor do Canadian programs have penalties for not adopting an EHR.

This combination of relatively low incentive dollars, lack of MU-style adherence programs and zero penalties means that EHR vendors in Canada are relatively free to pursue their own product roadmaps. There is less government and end-user pressure to build functionality simply to meet funding criteria. Instead, EHR vendors can focus more on what end-users really want (better user interfaces anyone?)

Reason 2 – PIPEDA vs HIPAA

Canada does have privacy legislation. It’s called PIPEDA and it places the onus on healthcare organizations to protect the personal identifiable health information of patients. At a high level the protections for health information under PIPEDA is similar to that of the US HIPAA laws.

The biggest difference, however, is in the attitude of healthcare providers towards PIPEDA vs HIPAA. In Canada PIPEDA is not thought of as a barrier to information sharing. Privacy is definitely a concern, but PIPEDA isn’t used as often as an excuse to prevent access to information.

Reason 3 – Single Payer

Each provincial government in Canada is the single payer for healthcare for its citizens. If you live in Ontario and you go to the hospital, the hospital bills the Ontario government for the care you received. There are no other payers involved, no co-pays, nothing.

For EHR vendors this makes payment processing and collection a lot simpler – giving them more time to focus on other areas of EHR functionality.

Reason 4 – Patient Identifiers

A beneficial consequence of the single-payer system is that every person in Canada has a unique patient identifier. Consolidating health information from multiple healthcare organizations is therefore much easier since every lab result, prescription, requisition and image has this unique identifier. It’s Canada’s built-in unique key.

Reason 5 – Sorry, eh.

Canadians by nature are very apologetic. We say “sorry” when people bump into us. We apologize when we feel we are inconveniencing someone else. It’s something in the water.

I’ve personally found Canadian end-users to be very tolerant and understanding of new technologies. It’s not in our nature to complain so things have to go REALLY wrong before we make it an issue. Admittedly I have a small sample size, but when I speak to HealthIT vendors doing business in Canada, I hear similar stories.

Conclusion

In combination, the 5 reasons above create an innovation-friendly environment for EHR vendors. Instead of having product functionality dictated by government legislation and financial incentives, vendors are free to incorporate real end-user feedback into their EHR platforms. They can push the usability envelop in a tolerant environment where privacy isn’t used as a blocker to progress.

Maybe I’m delusional, but I’m really hoping to see signs of EHR innovation at the upcoming #eHealth2016 conference. If you are an EHR vendor that’s doing business in Canada and you are doing something innovative with user experience or functionality I want to hear from you!

No Single Theme Dominated HIMSS16 and That’s Exciting!

Posted on March 8, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

HIMSS 2016 Attendance Numbers

Last week, over 41,000 people descended on Las Vegas for the annual HIMSS conference, #HIMSS16. Attendance was down slightly compared to the previous year, but it sure didn’t feel like it in the crowded hallways and aisles in the Sands Expo Center.

I truly enjoy HIMSS in Vegas. I find that people are more energetic and more willing to conduct business when the conference is held there. It feels like it is easier to have conversations with people in Vegas. Perhaps it is the oxygen they pump into the casinos or perhaps it is simply the aura of the town rubbing off on people.

Having impromptu conversations is one of things I love most about HIMSS. I always gain a tremendous amount of perspective when I randomly stop and chat with people in the exhibit hall. That trend continued this year, but after the first day, I felt something was missing from my discussions. It wasn’t until today that I realized what that was…there was no single consistent theme from #HIMSS16.

Over the past several years there has always been a single topic that dominated the conversations at HIMSS. Interoperability, Meaningful Use, Big Data, Patient Engagement and Population Health have all been hot-button HIMSS themes. This year, no single dominant topic emerged. There was certainly talk about gender parity, interoperability, moving to a value-based system, telehealth and Big Data, but there was no consistency to the conversations I had with fellow attendees.

I think this is a good sign. In fact, I’m excited about it.

HealthIT is in a state of flux right now. Meaningful Use is winding down, ICD-10 is in the rearview mirror and the hype around digital health is starting to wane. For the first time in years, vendors and healthcare CIOs are free to chart their own paths, pursue their own interests. This is something that hasn’t happened since the EHR incentive program started back in 2010.

Through this lens, the conversations at #HIMSS16 show me that we are about to see progress on many different fronts. Some people I spoke to are looking to invest in new decision support tools that employ the latest in artificial intelligence. Others are seeking new ways of using public data to assist in population health. Everyone I spoke to had one or two projects that they were FINALLY going to get a chance to start in 2016.

This is very exciting and I can’t wait to see how all this pent-up innovative energy manifests for the remainder of 2016.

#HIMSS16 Day 0 – Exhibit Hall Tetris

Posted on February 29, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Arriving the day before the craziness of HIMSS is an annual tradition for most vendors. The Saturday and Sunday before the main conference are the days when most of the booth building activity happens inside the HIMSS exhibit hall.

I have always enjoyed these pre-conference days at HIMSS. Being in the exhibit hall while booths are being constructed is like watching a life-sized game of Tetris. It’s fun to watch the army of tradespeople unpack crates and piece together complex booths while following instructions that look eerily like those you find with Lego building sets.

#HIMSS16 features move vendors than ever before. Over 1300 booths sprawl across multiple halls in the Sands Expo Center in Las Vegas Nevada. With this many vendors, the aisle-ways were especially difficult to navigate during setup. It’s a testament to the skill of the forklift drivers that they managed to squeeze all the crates in and round the booth areas for setup.

HIMSS16 Exhibit Hall 1

As a marketer and engineer, I relish the opportunity to have a preview of the booths before the hall opens. Every year I find at least five or six booths of unique/fresh design that I add to my must-visit list.

This year was no exception.

HIMSS16 Philips Booth
The Philips booth (3416) looks very impressive this year with four floor-to-ceiling LED displays that look like the ones they use in Football stadiums. The booth itself is beautifully accented with a stunning chandelier in the center. I can’t wait to see it in action when the hall opens.

The CDW Healthcare (3606), SalesForce (10525) and Cerner (2032) booths are also intriguing. I’m particularly interested in the SalesForce booth – partly because of the design but mostly because I’m curious to see how their healthcare offering is shaping up.

If you see a cool or interesting booth over the next few days, I hope you’ll tweet out a notification or post something to the HIMSS16 mobile app.